National Emergency Department Inventories (NEDI)

Objectives:

• To create nation-specific emergency department (ED) inventories;
• To collect basic characteristics of EDs to allow regional and international comparisons; and
• To inform local efforts to improve the accessibility and quality of emergency care.

Background and Significance: Since unplanned medical problems affect people worldwide, NEDI aspires to describe emergency healthcare systems around the world. The NEDI online survey identifies similarities and differences in EDs with a philosophy that different emergency healthcare systems can learn from one another. Using technology to facilitate cooperation, we hope that NEDI will serve as a platform for exchanging ideas on improving the accessibility and quality of emergency care for all.

Research Design and Methods: We will conduct nation-specific cross-sectional web surveys with the ED as the primary unit of analysis. (In larger countries, regional or even city-specific surveys also are encouraged.) A volunteer from each country who expresses interest in a leadership role will serve as the “Country Coordinator.” The Country Coordinator will be responsible for compiling a comprehensive list of all EDs in that country, with a contact person for each ED. The Country Coordinator then will email the internet address (www.emnet-nedi.org) to all ED contact persons and request that they complete the simple, self-administered online questionnaire. The survey was designed by Emergency Medicine Network (EMNet) staff to ask basic questions about ED characteristics and capabilities, while maximizing comparability of responses across highly diverse sites. To standardize the survey methodology, all questions will be asked in reference to a common time period of interest, for instance calendar year 2007. Sites without internet access will be invited to submit a paper survey.

Data Collection: All EDs in a given country will be invited to participate in NEDI by the Country Coordinator. The EMNet Coordinating Center at Massachusetts General Hospital (Boston, USA) has created the online form and will arrange professional translation of all study materials and template letters. The Country Coordinator will confirm that the translation is correct. The Country Coordinator then will assign site numbers locally, distribute the survey, and receive emails from sites upon survey completion to allow for tracking of respondents. EMNet will manage and analyze the resulting database, which will not have the identities of individual survey respondents. The Country Coordinator will be responsible for following-up with sites and sending reminders to non-respondents to achieve a >80% response rate.

Results: Once a country achieves a >80% response rate, EMNet will send the Country Coordinator summary statistics for the core dataset from their country. EMNet also will send the actual core dataset, if requested. The inclusion of hospital identity will depend on the role that the Country Coordinator plays in emergency medicine in their country. Country Coordinator’s with an appointed or elected position of responsibility for EDs in their country will be given the core dataset with hospital identity (i.e., actual hospital name and address) so that he/she can share data directly with each ED; the Country Coordinator will not share identifiable information, for example, about hospital B with hospital A. Country Coordinators who hold an elected or appointed position may need identifiable information to more directly improve emergency care in their country. Otherwise, the Country Coordinator will receive the de-identified core dataset (i.e. hospital names replaced with A, B, C, etc.). At the end of the survey, the Country Coordinator will report results to all survey respondents (and other groups) in aggregate form.

A template Microsoft PowerPoint presentation will be provided to the Country Coordinator to facilitate the dissemination of results to all ED contact persons in the country and with other interested groups. The presentation may include comparative data from other countries that have completed the study. Countries that successfully complete NEDI will also be announced on the EMNet website (www.emnet-nedi.org). Finally, the EMNet Project Coordinator and Dr. Carlos Camargo (overall EMNet Principal Investigator) will assist the Country Coordinator with more detailed data analyses and preparation of an original manuscript for submission to an appropriate medical journal.